Blood pressure lowering effect of an olive leaf extract (Olea europaea) in L-NAME induced hypertension in rats

A specially prepared olive leaf extract (EFLA 943) has been tested for its blood pressure lowering activity in rats rendered hypertensive by daily oral doses of L-NAME (NG-nitro-L-arginine methyl ester, 50 mg/kg) for at least 4 weeks. Oral administration of the extract at different dose levels at the same time as L-NAME for a period of 8 weeks showed a dose dependent prophylactic effect against the rise in blood pressure induced by L-NAME, best effects being induced by a dose of 100 mg/kg of the extract. In rats previously rendered hypertensive by L-NAME for 6 weeks and then treated with that dose of the extract for a further 6 weeks without discontinuation of L-NAME, normalisation of the blood pressure was observed. The findings confirm previous reports on the hypotensive effects of olive leaf. The special extract, EFLA 943, was shown to give consistent results with little individual variability. The antihypertensive effect of the extract may be related to a variety of factors involving reversal of vascular changes involved in the L-NAME induced hypertension.     

Intra-cerebral relapse following prolonged remission after autologous stem cell transplantation for multiple myeloma

Central nervous system (CNS) myeloma is a rare phenomenon, especially so after high-dose therapy (HDT) and stem cell transplantation. We describe a case of isolated CNS relapse of myeloma post autologous transplantation that followed a prolonged progression-free interval. Issues regarding the pathophysiology and management of this unusual complication are discussed.     

Pre-operative parent information and attitudes towards general anaesthetic induction technique in paediatric patients: An audit

Introduction It is a standard practice at our hospital to allow a parent to be present during induction of anaesthesia. Parents demonstrate a high degree of anxiety prior to their child's surgery. A struggling, crying child who then goes limp is emotionally upsetting to the parents ( 1 ). An anxious parent may increase the child's anxiety leading to various complications at induction. Adequate pre‐operative information regarding problems encountered during anaesthetic induction would help parents cope with this stress ( 2 ). The best practice would be that all the parents should be told about the preferred induction technique, intravenous or gas, an alternative technique if this fails and complications related to both. All parents should find the induction experience ‘better than’ or ‘as expected’ and be able to discuss their worries afterwards with a proficient member of the staff. The aim of this audit was to find out whether we gave adequate pre‐operative information to parents regarding anaesthetic induction and what were their attitudes towards this. Methods We designed a questionnaire which had two parts. Part A was filled in by the anaesthetist and part B by the parent who attended the induction. Results 50 patients were audited over a period of 3 months. Only 40% were told about both gas and intravenous induction. Only 58% were told why either technique was chosen. 10% of the parents found the induction experience to be ‘worse than expected’. 16% of the parents felt that the information given was ‘too little’. 12% were not able to discuss their worries afterwards with a proficient member of the staff. Conclusion Overall, the level of satisfaction was high with 90% of the parents finding the induction experience ‘better than’ or ‘as expected’. We fell short of the standards that we set up at the beginning of the audit. To improve parental satisfaction, adequate pre‐operative information is a must. Hence, considering a preoperative educational programme seems appropriate to improve our standards. We therefore make the following recommendations:

• 1 Detailed explanation by the anaesthetist to the parent regarding the general anaesthetic induction technique.
• 2 Use of audio‐visual aids, video‐tapes showing an anaesthetic induction.
• 3 Parental visit to the induction room to familiarise themselves with the environment.
• 4 Distribution of information leaflets to the parents explaining what to expect at anaesthetic induction.

Our next step is to design an information leaflet, put it on trial and then re‐audit.     

体重指数、代谢综合征和白细胞计数间的关系

肥胖和代谢综合征(M S)常常并存,两者都与心血管风险的增加有关。白细胞计数的增加也与心血管风险的增加有关。然而,人们对肥胖独立于M S之外的作用尚有争议。本研究拟评估M S对无症状患者肥胖与白细胞计数之间关系的影响。研究数据来自431例拟行心血管风险评估的无症状巴西男性(平均年龄46±7岁)。M S被定义为至少存在下列危险因素中的3项:高血压(≥130/85m m H g)、躯体肥胖(≥102cm)、高甘油三酯血症(≥1500m g/L)、高密度脂蛋白胆固醇水平低(≤400m g/L)以及高血糖(血糖≥1100m g/L)。肥胖的定义是体重指数≥30kg/m2。记录混杂变量…     

Human autopsy tissue distribution of the epipodophyllotoxins etoposide and teniposide

Autopsy tissues were collected from ten patients who had received etoposide, 150–3480 mg, from 1 to 412 days antemortem and from five patients who had received teniposide, 234–1577 mg, from 3 to 52 days antemortem. Tissues were assayed for etoposide and teniposide using high-pressure liquid chromatography with electrochemical detection. Etoposide was detectable in tissues of three of four patients dying <5 days after their last etoposide treatments to cumulative doses of 150–432 (median, 280) mg but was detectable in tissues of only one of six patients dying 7–412 (median, 37) days after their last etoposide treatment to a cumulative dose of 607–3600 (median, 1553) mg. The highest tissue concentrations were in the small bowel, prostate, thyroid, bladder, spleen, and testicle. Intermediate concentrations were found in the lymph node, skeletal muscle, adrenal gland, stomach, tumor, liver, lung, pancreas, and kidney, and the lowest concentrations were found in the heart, brain, diaphragm, vagina, and esophagus. Teniposide was detectable in one patient dying 3 days after a cumulative teniposide dose of 576 mg (spleen, prostate, heart > large bowel, liver, pancreas > thyroid, adrenal, stomach, small bowel, bladder, testicle, and skeletal muscle) but was not detectable in any tissue from four patients dying 5–52 (median, 8) days after their last treatment to a cumulative teniposide dose of 234–1577 (median, 520) mg. The very short tissue half-life contrasts with our previous observations for human autopsy tissue concentrations of mitoxantrone, doxorubicin, menogaril metabolites, diaziquone, and amsacrine. The short tissue half-life may help explain the schedule dependency of epipodophyllotoxin efficacy and may also help explain the lack of visceral toxicity of these compounds.This work was supported in part by a grant from Bristol-Myers Squibb Pharmaceutical Company     

Human autopsy-tissue distribution of menogaril and its metabolites

Autopsy-tissues were obtained from eight patients who had last received menogaril (total cumulative dose, 175–1080 mg/m²) intravenously (one patient) or orally (seven patients) from 1 to 285 days prior to death. Tissue samples were assayed for menogaril and its metabolities by high-pressure liquid chromatography. Unchanged menogaril was found only in a single lung-tissue sample from a patient who had died < 24 h after receiving his last treatment.N-Demethylmenogaril was found in two lung-tissue samples and in single samples of the thyroid, lymph node, pancreas, cerebellum, and tumor. The major menogaril metabolite found in human autopsy-tissues was 7-deoxynogarol. The highest 7-deoxynogarol concentrations were found in the large bowel (median, 201 ng/g), liver (median, 183 ng/g), and lung (median, 177 ng/g). The heart ranked as the 9th of 18 organs in median 7-deoxynogarol concentration, after the large bowel, liver, lung, tumor, thyroid, skeletal muscle, adrenal gland, and kidney. The lowest concentrations were detected in brain tissue. Our results suggest that the low degree of cardiac toxicity and the possible pulmonary toxicity of menogaril may be related to relative tissue concentrations of menogaril metabolites. Tumor 7-deoxynogarol concentrations were comparable with those in normal tissues, except that concentrations in intracerebral tumors were higher than those in the normal brain. Tissue 7-deoxynogarol concentrations appeared to be directly related to the cumulative dose and inversely related to the time from the last treatment to death; the value obtained by dividing dose by time correlated (P<0.05) with tissue 7-deoxynogarol concentrations.     

Bladder carcinoma. Experience with radical and preoperative radiotherapy in 421 patients

Four hundred twenty-one patients with bladder carcinoma were treated with radical intent between 1968 and 1981: 356 were treated with irradiation alone with megavoltage tumor doses of 60-66 Gy delivered over a period of 6 to 7 weeks. Actuarial 5- and 10-year survival was 66% and 58% for Stage A (58 patients), 42% and 35% for Stage B1 (62 patients), 35% and 28% for Stage B2 (120 patients), and 23% and 19% for Stage C (75 patients), respectively. Five-year survival after salvage cystectomy (47 patients) was 51% from the time of surgery, with 4 operative mortalities and a major complication rate of 30%. Sixty-five patients were entered into an integrated preradical cystectomy irradiation program. Fifty-three patients in stages B2-C-D1 received high-dose preoperative radiotherapy (40-50 Gy) before a planned, delayed radical cystectomy. The actuarial 5-year survival was 66% for 65 patients, and 64% for the 53 patients in the high-dose precystectomy program; major complications were encountered in 34% and there were 2 mortalities. Five-year actuarial survival for Stage B2-C was 30% but fell to 24% when patients with salvage cystectomy were excluded. Distant metastasis was found in 30% of patients in Stage B2-C-D1, and also in the high-dose precystectomy program patients. Two-thirds of patients with distant metastasis in the radiation alone group were never considered for salvage cystectomy as they had distant metastasis alone, persistent disease with metastasis within 6 months after initiation of irradiation, or local recurrence and distant metastasis simultaneously. Early local recurrence may be salvaged in 50% to 60% of patients without a significant increase in mortality or major complications. Accordingly, a program of radical irradiation with salvage cystectomy may avoid loss of the bladder in 45% of patients in Stage B2-C-D1 without compromising overall survival.